Briefing P033 - Health White Paper

Introduction

On 13th July 2010 the new Coalition Government published its proposals to reform the National Health Service and improve the health of the population. The document is in the form of a White Paper announcing a general policy direction and inviting responses as part of a consultation. In this case the Consultation closes in October. AS many of HVA’s members work in the field of Health and Social Care we are publishing this briefing to summarise the main points in the white paper and outline where groups can obtain further information about the proposed changes.

The aims of the White Paper are:-

  • put patients at the heart of everything the NHS does;
  • focus on continuously improving those things that really matter to patients - the outcome of their healthcare;

and

  • empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services


Background

The proposed reforms are intended deal with perceived weaknesses and inconsistencies in present arrangements. However the White Paper also takes place against an economic backdrop which requires the NHS to find savings of £20b by 2014.

Structural Changes

Perhaps the biggest structural change outlined in the White Paper is the abolition of the 10 Strategic Health Authorities and the 152 Primary Care Trusts. Under previous arrangements these bodies were responsible for evaluating the health care needs of a given population and commissioning services to address them.

GPs Move Centre Stage

Instead of a separate Commissioning body like a PCT the Government intend that groups of General Practitioners will form consortia and take on collectively many of the responsibilities. It is argued that General Practitioners have a good and detailed understanding of the health of local communities and would be best placed to commission services based on their needs. As many as 500 consortia could potentially be created. These bodies would be accountable to an independent NHS Board who would be responsible for ensuring consistent performance and that the new arrangements were fit for purpose.

Patient Information and Choice

Another key aspect of the changes involves giving patients more information and choice. To achieve this, a new body, HealthWatch, will be set up to compile data on GP/Hospital performance, while GP boundaries will be abolished to allow patients to register with any doctor they want.

The Government intend to:-

  • Increase the current offer of choice of any provider significantly, and will explore with professional and patient groups how we can make rapid progress towards this goal;
  • Create a presumption that all patients will have choice and control over their care and treatment, and choice of any willing provider wherever relevant (it will not be appropriate for all services – for example, emergency ambulance admissions to A&E);
  • Introduce choice of named consultant-led team for elective care by April 2011 where clinically appropriate. We will look at ways of ensuring that Choose and Book usage is maximised, and we intend to amend the appropriate standard acute contract to ensure that providers list named consultants on Choose and Book;
  • Extend maternity choice and help make safe, informed choices throughout pregnancy and in childbirth a reality – recognising that not all choices will be appropriate or safe for all women – by developing new provider networks. Pregnancy offers a unique opportunity to engage women from all sections of society, with the right support through pregnancy and at the start of life being vital for improving life chances and tackling cycles of disadvantage;
  • Begin to introduce choice of treatment and provider in some mental health services from April 2011, and extend this wherever practicable; 
  • Begin to introduce choice for diagnostic testing, and choice post-diagnosis, from 2011; 
  • Introduce choice in care for long-term conditions as part of personalised care planning. In end-of-life care, we will move towards a national choice offer to support people’s preferences about how to have a good death, and we will work with providers, including hospices, to ensure that people have the support they need;
  • Give patients more information on research studies that are relevant to them, and more scope to join in if they wish;
  • Give every patient a clear right to choose to register with any GP practice they want with an open list, without being restricted by where they live. People should be able to expect that they can change their GP quickly and straightforwardly if and when it is right for them, but

Trusts and Social Enterprises

The Government also announced he expected all NHS trusts, which run hospitals and mental health units, to get foundation status by 2013. This is accompanied by other changes which would be relax the rules which cap the amount of income a trust can make outside the NHS, opening the door to them seeing more private patients. The Government suggest that this would allow them to innovate and widen the scope of what they did. This appears to preface a greater role for social enterprise in health with hospitals effectively raising funds from private activity to offset or subsidise the costs of other aspects of its work. The White Paper will accelerate the trend towards a mixed economy in the NHS, with foundation trusts freed up to become social enterprises, opportunities for private companies to support GP commissioning and increased opportunities for independent providers to deliver treatment.

The Patient Voice

The White Paper seek to both extend and rationalise the influence patients have by combining the existing LINKS (local involvement in health networks) which will be subsumed into a body known as local HealthWatch, creating a local infrastructure, and we will enhance the role of local authorities in promoting choice and complaints advocacy, through the HealthWatch arrangements they commission. A review of other public engagement mechanisms across the NHS is also promised.

Local Authorities Take for Active Role

The White Paper also envisages a stronger role for Local Authorities in monitoring local Health Services. It also envisages a role promoting the joining up of services between health, social care and other areas such as Housing or Education. PCT responsibilities for local health improvement will transfer to local authorities, who will employ the Director of Public Health jointly appointed with the Public Health Service. The Department will create a ring-fenced public health budget and, within this, local Directors of Public Health will be responsible for health improvement funds allocated according to relative population health need. The allocation formula for those funds will include a new “health premium” designed to promote action to improve population-wide health and reduce health inequalities.

Implications for Third Sector Organisations

The White Paper is notable for the very few direct references it contains to Voluntary Organisations – although in its mixed economy approach it is easy to see that GP Consortia will be able to commission services directly from Voluntary Organisations. Over time groups will need to build relationships with GPs and to anticipate the new role for local authorities in the delivery of key public health targets. It is likely that the Health and Social Care Forum will be entering into discussions with NHS representatives over the next period to look at the detail of the proposal and make responses to the consultation.

Sources of Further Information and Analysis

The full text of the White paper can be downloaded here:-

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117352.pdf

The Kings Fund – an independent Charitable body examining imporovements in healthcare have provided initial analysis and comment which can be accessed via their website:-

http://www.kingsfund.org.uk/press/press_releases/the_kings_funds.html

 

Group Support: